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The purpose of this study is to apply a rhetorical lens to the exploration of symbolic interactions used to negotiate contested identity. Specifically, we provide and analyze an Internet discussion among nurses concerning job duties and responsibilities. In this case study, one nurse questions her superior's remarks about her “abandoning” her responsibilities if she does not undertake “non-nursing” tasks. Ironically, the majority of posts that follow from other nurses perpetuate the notion that nurses must perform “non-nursing” tasks to fulfill their primary moral obligation and sustain an identity of nurses as flexible and caring. A rhetorical lens is applied and suggests that multiple framing techniques and rhetorical tactics (i.e., mutual negation, minimization, red herrings, sunny-side of domination, and perhaps most important the moral imperative) are used to persuade the nurse toward a collective identity – flexible professional. Although the main contribution of this study is found in the use of the rhetorical lens, an additional contribution is discussed – unexpected evidence, which suggests that the primary assumption of a “nursing shortage” may be a discursive reality, as well.

Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.

This chapter examines the process by which men enter registered nursing. Research on men's entrance into atypical fields has looked at either motivational or career paths differences between men and women. I integrate these approaches by examining how men's prior work experience influences their subsequent career decisions and motivations. I find that men who are nurses are more likely to have had a prior health-care job, and this exposure helps them to recast nursing from a “female-only” job to an acceptable career choice. This reorientation job experience is a way for men to overcome informal barriers of “social control” (Jacobs, 1989) to entering a female-dominated occupation. These findings have implications for current efforts by many states and organizations that seek to expand the registered nursing workforce.

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.